Treatment of benign focal epilepsies in children: when and how should be treated?

Area of Science:

• Pediatric Neurology
• Epileptology
• Clinical Therapeutics

Background:

• Benign focal epilepsies (BFEs) constitute nearly 25% of childhood epilepsies.
• Key types include benign infantile seizures (BIS), Panayiotopoulos syndrome (PS), and benign childhood epilepsy with centrotemporal spikes (BCECTS).
• BFEs generally have an excellent prognosis, necessitating careful consideration of antiepileptic drug (AED) risks and benefits.

Purpose of the Study:

• To review current expert opinions on managing BFEs.
• To guide AED selection and treatment duration for BIS, PS, and BCECTS.
• To emphasize individualized treatment approaches based on seizure characteristics and patient factors.

Main Methods:

• Review of expert opinions and clinical practice guidelines for BFE management.
• Analysis of recommended AEDs for specific BFE types (BIS, PS, BCECTS).
• Discussion of treatment duration and individualized patient considerations.

Main Results:

• AED treatment is typically reserved for patients experiencing multiple seizures.
• Specific AED recommendations vary by BFE type and geographic region (e.g., CBZ for BIS, VPA/CBZ/CLB for PS, CBZ/VPA for BCECTS).
• Treatment duration should be minimized, ideally under 2 years, irrespective of EEG normalization.

Conclusions:

• Individualized treatment is crucial for BFEs, considering seizure frequency, circadian patterns, EEG, neurodevelopmental status, and parental preferences.
• While generally benign, atypical evolutions in BCECTS warrant attention.
• The goal is to minimize AED exposure while managing seizure activity effectively.